Incontinence is the leaking of urine or feces at the wrong time and place. Most often this occurs when pelvic floor muscles are weak, the pelvis unstable or the back painful. Constipation can be caused by dietary choices and dehydration as well as incoordination of the pelvic floor muscles. After evaluation by your health care provider, treatment includes evaluation of these muscles, learning how to strengthen and use them to control the leaking. This is effective for both stress incontinence (leaking with coughing, sneezing or jumping) and urge incontinence (having to go so badly you cannot make it to the toilet.)
In order to more fully understand your bladder symptoms, it is important to review the different types of bladder problems and the factors that contribute to them.
Stress Incontinence
Stress Incontinence is the involuntary leaking of urine, often at inappropriate times, during periods of coughing, laughing, sneezing, heavy lifting, orgasm or strenuous sports activities. Usually only small spurts of urine are lost but it is certainly enough to be bothersome. Leaking occurs when the pressures pushing on the bladder from the abdomen are greater than the strength of the muscle of the urethra (tube) to hold urine in.
Urge Incontinence
Urge Incontinence is the involuntary leaking of urine that is accompanied by a strong urge to urinate. Leaking is often associated with certain triggers such as approaching a toilet, putting a key into a lock, or running water. The bladder contracts uncontrollably, often emptying all of its contents. Urine loss can occur as drops or “gushes”, depending on how much urine is in the bladder. It is devastating to women who can entirely soak their clothes and everything nearby. It is usually accompanied by feeling of urgency and frequency caused by overactive bladder or interstitial cystitis.
Overactive Bladder
Overactive bladder is a strong feeling of urgency usually accompanied by frequency of urination and incontinence. It is caused by “overactivity” or uncontrollable contractions of the bladder muscle (detrusor muscle). Frequent nighttime trips (2-4) to the bathroom are common.
You may have urge incontinence or overactive bladder if you:
Are tired from getting up 2 or more times a night with feeling of urgency.
Are unable to work because there is lack of availability of toilets.
Know where all the toilets in the mall are.
Have gushes when approaching the toilet or washing the dishes.
Mixed Incontinence
Mixed incontinence is a combination of both stress and urge incontinence which is more commonly seen as women age. The incontinence is often described as urge dominant or stress dominant, depending on which symptoms are more prevalent.
What Factors Contribute to Bladder Problems?
Bladder problems affect over 17 million men and women but are much more common in women as they age. Aging does not cause bladder problems but certain changes that occur can make a woman more prone to developing problems with her urinary tract. Factors which can contribute to bladder problems are many and varied.
Menopause
Women in menopause have declining levels of estrogen which causes the mucosal lining (inner skin) the vagina and urethra to thin. Normally the urethra closes together like Velcro but with menopause, the urethra is less spongy and doesn’t close tightly allowing urine to leak out. The healthy vagina also helps support the bladder in its proper place. As the vaginal layer thins, the bladder may drop because it has less support. Incontinence can occur.
Pregnancy
Pelvic organs are displaced and muscles are stretched due to increased abdominal pressures during pregnancy and the stretching of the pelvic muscles during delivery. Bladder problems worsen with multiple pregnancies, long labors, and large babies.
Hysterectomy
Hysterectomy decreases the pelvic support with the removal of the uterus. The surgery itself may also cause scar tissue, a decrease in blood flow, and muscle problems.
Neurological factors
Conditions such as diabetes, multiple sclerosis, and Parkinson’s disease may affect the bladder. The filling and emptying of the bladder is controlled by nerves which may be affected by neurological conditions.
Other Factors That May Contribute To Incontinence:
Heredity – if your mother has weak muscles you might also.
Previous surgery in the pelvic area – may reduce blood circulation to the area.
Habitual straining with chronic constipation – may stretch the muscles.
Restricted mobility - may result in an inability to get to the toilet in time.
Chronic cough often associated with lung problems – may increase abdominal pressure on the bladder and stretch the pelvic floor muscles.
Obesity – may add to the chronic strain against the pelvic floor muscles.
Occupations associated with heavy lifting – may stretch the pelvic muscles.
Cigarette smoking - may irritate the bladder and increase the likelihood of coughing.
High impact physical activity – may jolt and put undo strain on the pelvic muscles.
Advancing age – may decrease circulation to the muscles and tissues in the pelvic are. Often associated with declining estrogen levels.
Lack of preventative exercising of the pelvic floor!
The Muscles of the Pelvic Floor
The bladder and urethra are supported by a flat group of muscles known as the pelvic floor muscles. These muscles, much like your kitchen floor, need to be maintained or else they will deteriorate. The muscles lie underneath the bladder and act as a backboard or trampoline to support the organs in your lower pelvis. There are no side wall supports. Some of these muscles form a U-shaped sling which attaches to the pubic bone in front and the coccyx in back at the base of the spine. This creates a hammock-type structure to support the bladder in its proper place. As the sling stretches with various conditions such as pregnancy, the support of the bladder decreases and the relationship of the bladder and urethra to their surrounding structures changes. Bladder problems result.
